Aug. 27, 2009 -- Psoriasis can lead to physical scars, but the emotional
scars from the skin disease can run deeper.

The thick, red, scaly skin lesions that characterize the condition often
influence how people with psoriasis feel about themselves and how others see
them.

Now new early research suggests that the brains of some patients may
actually adapt to cope with the body image and self-esteem issues that can
accompany the skin disorder.

Using brain imaging focused on an area of the brain believed to control
feelings and reactions to disgust, researchers in the U.K. showed that
psoriasis patients tended to react less strongly to facial expressions
registering disgust than people without the skin condition.

The study was small, with just 12 men with psoriasis and 12 men without the
skin condition.

But the findings suggest the brains of psoriasis patients eventually become
rewired to protect against the negative emotional responses of others,
researchers say.

The research appears in the latest issue of the Journal of Investigative
Dermatology.

"Psoriasis can be a very stigmatizing condition, but this is often not
factored in to decisions about treatment," dermatologist and study researcher
C. Elise Kleyn of the University of Manchester tells WebMD.

She says a clear understanding of how psoriasis affects a patient's
psychological state is important for determining how aggressive treatment
should be.

Dermatologist Jason Reichenberg, MD, of the University of Texas Medical
Branch at Austin, agrees.

He says clinicians still typically focus on how much of the body is affected
by psoriasis when they make decisions about treatment. The National Psoriasis
Foundation defines mild psoriasis as affecting less than 3% of the body. Skin
coverage of 3% to 10% is considered moderate, and coverage of more than 10% is
considered severe.

Treatments for the skin disorder run the gamut, from moisturizers, coal tar,
and other remedies to immune-system targeting biologics.

Emotional Impact of Psoriasis

"Having a circle of psoriasis the size of a quarter on the forehead is going
to have a different impact than the same-sized circle on a largely hidden part
of the stomach," he says. "I see patients who are so paralyzed by this that
they are unable to have intimate contact with other people."

He adds that there is a growing awareness among dermatologists of the
importance of considering the psychological impact of psoriasis when making
decisions about treatment.

And several small studies suggest that efforts to improve a patient's
psychological state, such as treating with antidepressants or teaching
relaxation techniques, can improve treatment outcomes.

Studies show that a large percentage of psoriasis patients are unhappy with
the treatments they are getting, Reichenberg says.

"I would urge patients who are having trouble dealing with the psychological
aspects of their psoriasis to make their feelings known to their physician," he
says. "More and more patients are doing this, and taking control of their
treatment."